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Ask the Experts - Surgeons
Answers provided by Guy Slater & Shaw
Somers, Streamline Surgical consultants
1.
Who is eligible for weight loss surgery?
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| Usually to qualify for surgery, patients need to
have a BMI of over 40 if they have no illnesses related
to their obesity or over 35 if they have got obesity
related illnesses. Those criteria aren’t
hard and fast if you are a private patient occasionally
we will go a bit lower for individual patience with
the right circumstances but for NHS patience often
the criteria is set much higher by their primary
care trust and you may not be eligible for funding at
that level. |
7 Is there anything I can do to lower my risk for surgery?
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| Before
surgery we advise patients on a number of things they
can do to reduce the risks of the operations. Such as
stopping smoking, going on a diet to prepare the body
and make the surgery easier and also to maintain as much
fitness as possible by walking, making sure you try and
do the stairs, that kind of thing and that can significantly
improve the chances of getting through surgery without
any problems. |
9 How long does the operation take?
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| The time the operation takes really is determined by a lot of different patient factors, it really takes as long as it is going to take to do it safely. On average a band would take about an hour and a bypass would take an hour and half to two and half hours, that sort of length of time in theatres. |
11 What sort of pain will I have after the surgery?
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| After surgery most people experience a bit of discomfort in the upper stomach, they will feel like they've got a bit of tummy ache and we treat that with what we call a patient controlled analgesia devise, where they press a little button and they can have a dose of pain killer. Usually after 24 hours, most people can manage with just standard soluble pain killers. |
12 How bad are the scars?
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| For
key hole surgery there are usually between 4 and 6 scars
about half an inch across, dotted around the upper tummy.
With open surgery, for bypasses there is a scar about
4-6 inches long between the bottom of the breast bone
and the tummy button. Those scars most people will accept
as being reasonable and not very obtrusive. |
13 How do you decide whether to do a keyhole or open surgery?
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| The
decision about the route for surgery, whether key hole
or open, largely comes down to the suitability of the
patient for keyhole surgery. When we do a key hole operation
we rely on very fine instruments being inserted into
tubes through the tummy wall and certain builds of patients
like very muscular patients or patients who have got
all their weight on their tummy can be very difficult
to maneuver the instruments to do the operation safely.
Since safety is our number one priority it is just better
to do it with an open cut. |
14 Why
do I have to see a dietician as well as you?
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| I
think it is very important as part of a full assessment
to see a dietician. It is really only often when patients
work with a dietician that they realise exactly what
they are eating and the diet is very important in making
the decision between band or bypass. If it turns out
the patient does eat a lot of sweets, chocolate, crisps,
things like that, then they may do badly with a band
and they may be better advised to have a bypass. |
15 Why do I have to do
a pre surgery diet?
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| The
pre surgery diet is really important from my perspective,
it is basically an ultra low calorie diet, really aimed
at shrinking your liver as where we are operating really
lies right behind the liver so anything you can do to
make the liver smaller makes the surgery much more straight
forward for us and potentially safer for you. |
16 I have diabetes
type 2, can you cure it with a band or bypass?
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| It
is interesting diabetes and the effect of surgery on
it. There is no doubt that it can be cured with both
forms of surgery, although overall bypass surgery is
more reliable in terms of curing diabetes and often that
cure is independent of weight loss, so from the moment
you've done a bypass you may make a patient non-diabetic.
That happens in about fifty percent to two thirds of
cases, whereas with a band it is more about gradual
weight loss and as you loose
the weight you may find your diabetes is cured. |
18 Why do I have
to take vitamins after my surgery?
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| Patients with a gastric bypass should take vitamin tablets after surgery, that is because the stomach is no longer the transit route for food and so certain vitamins that are only absorbed in the stomach will no longer be absorbed properly and if you take a vitamin tablet that helps the rest of the intestine absorb enough vitamins to keep the rest of the body in tack. |
19 Why do you take
my gall bladder out?
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| If
people loose a lot of weight whether it is by surgery
or by dieting, you can develop gall stones which require
further treatment, so we are quite aware that weight
loss surgery is a cause of gall stones. Now if someone
has gall stones at the time we are doing the weight loss
surgery we will probably take the gall bladder out as
long as it doesn't make the operation too complicated.
If someone doesn't have gall stones, we will sometimes
take the gall bladder out but that depends on whether
it would make the operation more difficult or not and
it is something that we would discuss individually. |
20 Will I need plastic
surgery once I have lost all the weight?
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| Ideally
everybody would be eligible for plastic surgery after
they have had their operation when they loose weight.
The appearance of your abdomen after surgery differs
a lot from patient to patient. Some patients have a very
good result and some patients unfortunately get quite
a lot of saggy skin and they would benefit from plastic
surgery. The difficulty is that generally speaking, other
than in exceptional circumstances, it is not available
on the NHS. |
21 Is it true that
my hair will fall out?
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| Following
successful weight loss, some people can experience thinning
of the hair due to that rapid weight loss and it is commonly
seen after pregnancy, but it can happen after bariatric
surgery. It occurs usually between three and six months
after the operation. It is very, very rare for people
to have noticeable hair thinning but there is a faster
turnover of hair and some people may notice that it has
shed a lot more quickly when they wash their hair. |
23 What is dumping
syndrome?
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| Dumping
syndrome is a condition that patients will experience
if they eat the wrong type of foods. So for instance,
if you were to have a bowl of chocolate ice cream, that
ice cream after a bypass goes straight into the small
intestine which really doesn't like having neat ice cream
put into it or dumped into it. The reaction of the body
is that patients start to feel shivery, sweaty, tired,
unwell and that lasts an hour or two and it is directly
related to having something sweet and calorific and it
puts you off. So from our point of view, it is a necessary
side effect to give the patient the incentive not to
eat the wrong things. |
25 Why can’t
I have alcohol after my surgery?
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| I
think after particularly bypass surgery the way your
gut absorbs food and fluid is changed marginally so I
think you need to be careful with alcohol and certainly
I would avoid it completely for six week or so and they
have it in moderation, slowly reintroducing it but certainly
not drinking to excess. With the band it is less of an
issue. Certainly in the first few months you wouldn't
want to drink to excess, you wouldn't want
to make yourself vomit which could cause the band to
displace. |
26 Why can’t
I have fizzy drinks any more?
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| We
ask patients to be very careful with fizzy drinks because
the pouch which accepts fluids is much smaller. If you
can imagine pouring a fizzy drink into a small cup, the
bubbles will easily overflow if the cup is
quite small and that will happen if they swallow a fizzy
drink into their stomach pouch, the stomach pouch will
overflow and the bubbles, unfortunately, will come up. |
28 What is head hunger?
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| Head
hunger is a particular feeling that patients get when
they know that they don't feel physical hunger, they
don't want food but they need to feel that they are going
to eat something. It is part of the psychological
makeup of craving foods and being dependent on foods
for comfort and it is something we spend some time with
patients discussing and dealing with after an operation. |
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